Throwing patients a lifeline

June 14, 2018 Jane Coutts

Game changing technologies promise accessible care

The prognosis was grim for the month-old baby. Suffering respiratory failure, the infant was brought to the La Loche Health Centre desperately in need of specialist care — just as a three-day snow storm began. Air transport was out of the question, and the 600-kilometre ambulance ride might have taken 18 hours.

It was safer by far to keep the baby at the health centre — thanks to the specially designed robot that links doctors in the remote town to expert providers in Saskatoon.

“We could not get the baby out safely, so having access to a consultant was essential, and so was access to a respiratory therapist, who could take our adult ventilator and tell us how to adapt it for a neonate,” said La Loche’s Dr. Brian Geller “That baby almost certainly would have perished if we had not had access to the robot.”

Long-distance consulting is not new for remote communities. What makes the robot so effective is its range of built-in functions, Dr. Geller explained. Its “remote presence technology” includes a stethoscope, a zoom on the high-resolution camera and the capacity to link to other sources of information. Unlike telehealth systems, it can move to and around patients, steered by the long-distance doctor. The combination permits far-away consultants to assess, diagnose and manage ongoing patient care.

The robots were developed by Dr. Ivar Mendez, head of the Department of Surgery at the University of Saskatchewan. For Dr. Geller, the La Loche robot constitutes “an extra set of eyes — distant both literally and figuratively — because they can sort of step back and take a bigger picture, which is sometimes hard to do when you’re in the heat of the moment with a whole lot of activity going on around you.” His only complaint is that for now, it’s only approved for pediatric care.

Regina family physician Barbara Konstantynowicz hasn’t had a robot added to her team, but she expects a virtual care tool called Reacts will revolutionize her practice just as much. Reacts (an acronym for Remote Education, Augmented Communication, Training and Supervision) is a secure video collaboration platform created by Quebec’s Innovative Imaging Technologies Inc. and brought to Canadian physicians by Joule Inc., the Canadian Medical Association’s newest subsidiary.

More than just a videoconferencing tool, Reacts offers secure transfer of all kinds of files, plus options where a remote consultant can supervise and guide the physicians who are with patients — perhaps pointing out what an ultrasound is revealing in real time, or taking them step-by-step through an assessment. It has a stethoscope, an otoscope and a dermascope for looking at skin lesions.

While the benefits of virtual care for physicians in rural and remote practice are obvious, the need for them might seem much reduced in the city. But Dr. Konstantynowicz can see huge benefits for her patients. One, with quite serious diabetes, spends part of each year in another province. He was thrilled at the prospect of being able to make a video appointment if his numbers were off, or if he had a scrape on his leg that perhaps ought to get seen to.

Then there are the numerous elderly patients that make up a practice, for whom regular appointments in Regina’s brutal winters are a real burden. Not all have computers, of course, but one 90-year-old patient who loves her iPad is looking forward to not heading out in -40 degree temperatures for an office visit, while Dr. Konstantynowicz is reassured that she’ll still be able to see her patients, since assessing overall appearance is such an important part of  elder care.

For Dr. Konstantynowicz, who says she can just about manage to take a picture with her phone, the tool is amazing — from its most impressive capabilities to the practicality of its simplest functions. It is clearly inconvenient for her patients to have to come in to the office to get straightforward test results, or have an on-going condition checked on. But fee for service rules require it, or she does not get paid. And in any case, information privacy and security concerns put e-mail and texts out of bounds.

 “How much more could I get done in the day if I had some other means of communication other than forcing people to come into the office?” she asks. Reacts opens up that possibility: its secure “tunnel” encrypts all forms of communication, and a subscription gives her access to 1,000 communication partners. She doesn’t think she’d use it for every patient, but for some it would be a real lifeline.

Case in point: a young woman with a spinal cord injury, for whom every trip outside the house is enormously complicated. Dr. Konstantynowicz visits her once or twice a year for checkups, but the woman often gets pressure ulcers, and winds up in emergency for treatment. With Reacts, paramedics could go to the house using the dermascope at Dr. Konstantynowicz’s direction — and a specialist could be included in the call. It’s clearly a better way for that patient to receive care.

“I’d love this to change my practice,” she said. “I’m an old doc, so I started medicine forever and a year ago and I have seen so many changes in healthcare, but this is one I am super excited about.”

She sees another benefit, beyond her own practice as well —that the high-tech edge it gives to care might attract more students to family practice.

“I think that our system has moved away from family physicians. Our young docs want the security, or the ability, that high-tech things bring. But I think if we make it super cool to be a family doc again, that patients will thrive, and we will have a future in family medicine again.”

 

This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Jane Coutts is an Ottawa-based writer and editor who specializes in healthcare issues. She worked as a journalist for 15 years, mainly at The Globe and Mail, where she was the health policy reporter for five years. Since she founded Coutts Communicates in 2002, Jane’s work has focused on making healthcare policy and research more readable and relevant. Jane also leads workshops plain-language writing.

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